Protocol: Airway Management Guidelines

Original Effective Date: 01/01/2001 | Revised Date: 01/01/2002

BLS | ILS | ALS PROTOCOL

INTRODUCTION:

A secure airway in any patient is an essential element in resuscitation and ultimately survival. It is the first priority with every patient. In order to manage the airway of a wide variety of patients it is incumbent upon the EMS provider to be skilled in all approved airway management techniques and to use careful judgement in the selection of a technique. There are few elements of patient care more demanding of skill and judgement than airway management.

PROCEDURE:

  1. Approved Airway Techniques

    Basic Life SupportAdvanced Life Support
    1. Jaw Thrust and Chin Lift
    2. Nasopharyngeal trumpet
    3. Oropharyngeal airway
    4. CombiTube
    5. Oropharyngeal suctioning
    1. All BLS Techniques
    2. Orotracheal intubation
    3. Blind nasotracheal intubation
    4. Digital intubation
    5. Surgical Cricothyroidotomy

  2. Airway Management (no specific order) in patients without c-spine trauma.

    1. Intact gag reflex

      Basic Life SupportAdvanced Life Support
      1. Head Positioning
      2. Jaw and chin maneuvers
      3. Nasopharyngeal trumpet
      4. Suctioning (as needed)
      1. All BLS Techniques
      2. Orotracheal intubation
      3. Blind nasotracheal intubation
      4. Orotracheal Intubation (possibly)

    2. Absent gag reflex

      Basic Life SupportAdvanced Life Support
      1. All techniques above in #1
      2. Oropharyngeal airway
      3. CombiTube
      1. All BLS Techniques
      2. Orotracheal intubation (preferred)
      3. Digital Intubation
      4. Surgical cricothyroidotomy

  3. Airway Management of the Trauma Patient. (In-Line Stabilization Must be Utilized!)

    1. Intact gag reflex

      Basic Life SupportAdvanced Life Support
      1. Head positioning to neutral
      2. Jaw Thrust maneuver
      3. Nasopharyngeal trumpet
      4. Suctioning
      1. Blind Nasotracheal Intubation
      2. Orotracheal Intubation

    2. Absent gag reflex

      Basic Life SupportAdvanced Life Support
      1. All techniques above in #1
      2. CombiTube
      1. Orotracheal intubation (preferred)
      2. Blind Nasotracheal Intubation
      3. Surgical cricothyroidotomy

SPECIAL CONSIDERATIONS/NOTES/PRECAUTIONS

  1. Careful attention to the patency and adequacy of a patient's airway is critical and will require repeated assessments.
  2. The maintenance of an airway should involve use of the least invasive or least hazardous technique necessary to insure patency. The EMT is expected to select from the available techniques the one most appropriate for a particular patient.
  3. Careful and accurate documentation on the EMS Report is mandatory.
    1. Method(s) chosen
    2. Number of attempts
    3. EMT performing procedure
    4. Whether ultimately successful and by what determination
    5. Probable cause(s) attributing to any failed attempts

Cricothyrotomy (Advanced Life Support Only)

  1. May only be performed by paramedics specifically trained in the procedure.
  2. May only be performed as a life saving technique when no other procedure is successful.
  3. Medical Direction via radio, cellular, or land line suggested but procedure may be performed without direct order when circumstances preclude prior communication.
  4. Documentation of cricothyrotomy will be thorough and formal notification by phone or pager made to the EMS Service Director within 24 hours following procedure.

CombiTube (Basic / Intermediate Life Support)

  1. Medications may not be administered via CombiTube.
  2. Do Not remove a functioning CombiTube to insert an ET Tube in its place unless there are compelling reasons to do so (i.e., need for airway administration of medications, inadequate ventilation of the patient, penetrating neck trauma complicated by CombiTube placement).

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